Guidewire: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
Charmaine Patel (talk | contribs)
nocaptcha
14,570 edits
 
(128 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
{{SI}}
{{SI}}


{{CMG}}
{{CMG}}; '''Associate Editor-In-Chief:''' Priyantha Ranaweera [mailto:pranawee@bidmc.harvard.edu];  
__NOTOC__
'''Associate Editor-In-Chief:''' Faizul Haque, M.D. [mailto:fhaque1@bidmc.harvard.edu]; Priyantha Ranaweera [mailto:pranawee@bidmc.harvard.edu];  
 
{{Editor Join}}
 
==CORONARY GUIDE WIRES==


===SIZES===
'''''Key Words and Synonyms:''''' PCI guidewire; angioplasty guidewire; coronary guidewire; steerable wire; steerable guidewire.


====CORE DIAMETER====
==Overview==
Angioplasty guidewires are small, soft, flexible, lubricated, wires that act as a rail over which equipment such as an angioplasty balloon, a stent, or an intravascular ultrasound device can be delivered over into the coronary artery.  Angioplasty guide wires were introduced in 1982 by doctors Simpson and Roberts. The introduction of coronary guidewires was a major advance as it allowed the angioplasty balloon to be a traumatically steered to the proper location.


0.010” -  0.018”
==[[Guidewire general techniques|Guidewire Techniques]]==
Commonest 0.014”
Some wires have tapering ends (eg .014” tapering to .010 “)


====TIP DIAMETER====
==[[Guidewire complications|Guidewire Complications]]==


Usually 0.014” – 0.009”
==[[Guidewire desirable performance characteristics|Desirable Performance Characteristics of Coronary Guidewires]]==


====LENGTH====
==Guidewire Design Features==
 
A guidewrie has three main components - a core, a tip and a lubricous Coating.  
Standard length : 175-190 cm
Exchange length : 270-400 cm
 
If using a standard length wire and need an exchange length wire, use a docking system to mount another standard length wire
 
(caution – docking joint is prone to “snapping” when bent, also the docking joint may give way)
 
When using an exchange length wire and delivering a balloon or a stent, a magnet may be used to hold the wire in place. (preferably this is a two operator procedure. )
 
===PHYSICAL CHARACTERISTICS===
 
Has three main components - Core, Tip and the lubricous coating.  


[[Image:Components_of_a_guide_wire.jpg]]
[[Image:Components_of_a_guide_wire.jpg]]
Line 40: Line 22:
Figure : Components of a guide wire (courtesy : Abbott vascular inc)
Figure : Components of a guide wire (courtesy : Abbott vascular inc)


In some wires the core extends up to the tip. In others the tip is made of a different material
[[Guidewire Core]] | [[Guidewire Coatings]] | [[Guidewire Tip]]
 
===CORE===
 
The core is usually ground to a taper towards the end for the tip to attach.
 
If core starts tapering more towards the tip, the wire as a whole becomes more rigid, steerable and torquable.
 
The opposite happens when the core tapers more proximally allowing for a longer tip.
 
The core may be continuous or joined (more likely to bend on wire advancement if joined)
 
====COMPOSITION====
 
Nitinol, stainless steel or similar metal
 
====TYPES OF CORE MATERIAL====
 
====NITINOL====
 
[[Image:nitinol.jpg]]
 
====ADVANTAGES - NITINOL====
 
Super-elastic alloy designed for kink resistance
Excellent flexibility and steering
Probably more durable nature
Better trackability
Less prolapse.
 
====DISADVANTAGES - NITINOL===
 
Stores torque without necessarily transmitting it to the tip  Wires with single nitinol cores could “ wind up”
 
Less torquable
 
====CLINICAL CORRELATION - NITINOL====
 
Nitinol wires are more likely to enter a retroflexed circumflex
 
====STAINLESS STEEL====
 
Original core material technology
 
[[Image:stainless_steel.jpg|(Courtesy of Abbott vascular)]]
 
===ADVANTAGES – STAINLESS STEEL====
 
Gives more pushability, torquability, and good shapeability in “core-to-tip” wires.
Good support, push force and torque
 
====DISADVANTAGES – STAINLESS STEEL====
 
*Tendency to kink
*Less flexible than newer core materials
 
===OTHER MATERIAL USED IN THE CORE===
 
===High tensile strength stainless steel===
[[Image:High_tensile_strength_stainless_steel.jpg]]
 
*More durable than regular stainless steel
*Retains shape more
*Improved flexibility
*Improved steering and tracking
 
===Asahi Tru Torque Steel===
[[Image:Asahi_Tru_Torq_Steel.jpg]]
 
==LUBRICIOUS COATING==
 
One or both of
 
*Hydrophilic
*Hydrophobic
*Hydrophobic tip and hydrophilic distal end
 
*Affects lubricity, friction and  wire tracking in crossing lesions as well as during stent and balloon delivery.
 
*Facilitate smooth movement
 
*Confined to the distal 30-35 cm
 
==Commonly used coatings==
 
1.PTFE (Polytetrafluroehylene) - commonest
 
2.Teflon
 
3.Silicone
 
4.Pro/Pel®, (Medtronic)
 
5.Hydro-track® (Medtronic)
 
6.Hydro-coat (Abbott vascular)
 
===HYDROPHILIC COATING===
 
*attracts water
*It is applied over polymer or stainless steel (including tip coils)
*Thin, non-slippery solid when dry, needs lubrication to perform
*Becomes gel when wet
*Reduces friction
*Increases trackability
 
===HYDROPHOBIC COATING===
 
*repels water
*Silicone on working area of wire, excluding tip
*No actuation/wetting required
*Reduces friction
*Increases trackability
 
Platinum in the tip for radio-opacity. (usually 3-25 cm length at the tip)
 
===TIP OF THE INNER CORE WIRE===
 
===CORE TO TIP GUIDE WIRES===
[[Image:core_to_tip.jpg]]
 
When the core is extended to the tip, that increases pushability, precise steering, tip control and torquability. This can be a useful feature for eg. in probing chronic total occlusions.
 
With unibody wires there is more torquability, pushability and tactile feel. With two piece tip wires shaping is easy and the wire is likely to retain the shape “wire memory”
 
===SHAPING RIBBON===
 
Softer tip allowing shape retention
[[Image:shaping_ribbon.jpg]]
 
===TIP OF THE GUIDE WIRE===
 
===SPRING COIL TIP===
 
1. Spring coil - Safer than hydrophilic coated or polymer tip wires - less risk of perforation
 
2. Distal weld
 
===SPRING COILS===
 
*Outer coils only
[[Image:Spring_coil_outer_only.jpg]]
*Tip coil only
[[Image:Spring_coil_tip_only.jpg]]
 
[http://www.example.com link title]
 
===TIP COVER===
 
*Polymer or plastic
*Provide lubricity
*Smooth tracking through tortuosity
 
[[Image:covers.jpg]]
 
=====POLYMER TIP (COVER)=====
 
Polymer instead of the spring coil with hydrophilic coating
 
Improved trackability with the compromise of reduced tactile feedback / feel
 
Eg: PT Graphix™ Intermediate Guide Wire, ChoICE PT wire
 
=====”COMBINATION” TIPS=====
 
*Tip coils plus
*Intermediate coils
*Bare core
*Plastic cover
*Polymer
*Polymer over tip coils
 
As lubricity increases the amount of tactile feedback decreases. This partly accounts for the increased risk of perforation with hydrophilic coated wires.
 
[[Image:Relationship_of_lubricity_to_tactile_feedback.jpg|thumb|350px]]
 
Courtesy: Abbott Vascular
 
=====TIP LOAD=====
 
One way of quantifying some of these physical features is by measuring with a strain gauge, the force needed to bend a wire when exerted on a straight guide wire tip, at 1 cm from the tip.
 
Using this method , the tip loads in ascending order are 3gm, 4.5 gm, 6gm, 9 gm and 12 gm (ultra stiff)
 
As stiffness increases the wire becomes prone to perforation
 
 
=====FLEXIBILITY OF TIP=====
 
 
=====DETERMINANTS OF TIP FLEXIBILITY=====
 
 
=====JOINT=====
 
There is one or more joints in the wires with tip material some different to core material.
 
The number of joints and the nature of them influence the clinical performance of the wires. The joints could serve as hinge points and bend during guide wire passage.
 
 
[[Image:Joint_wire_bends.jpg]]
 
====COMMON TERMS USED TO DESCRIBE CLINICO-PHYSICAL PROPERTIES OF GUIDEWIRES====
 
=====SUPPORT=====
 
Is a measure of
 
*Overall performance
*Smooth traverse through complex lesions
*Smooth device tracking.
 
 
====STIFFNESS====
 
Is a combination of diameter, trackability and torque control. Stiffer wires give better torque control and straighten the vectors of forces pushing the wire, balloon or a stent.
 
This quality can be useful in crossing chronic total occlusions as well as when delivering a stent or balloon in a straight segment and can work against delivering a stent or balloon in a tortuous or an angulated segment.
 
Stiffer wires are more likely to cause pleating artefacts and also bury in to the intima in a “cheese cutter” effect. ( Eg Iron man wire)
 
====MALLEABILITY====
 
Ability to be shaped or bent without breaking
 
====TORQUE CONTROL====
 
Is the ability to transmit rotational forces from the operators hand to the tip.
Directly proportional to diameter,
May be assisted with the use of a “torquer” or a “pin vise” or “steering tool”.
 
====STEERABILITY====
 
Is the ability of a guide wire tip to be delivered to the desired position in a vessel.
 
It  is a combination of all of the physical properties of the guide wire combined with the skill of the operator.
 
====STEERABLE GUIDE WIRES====
 
 
=====FLEXIBILITY=====
 
Is the ability to bend with direct pressure.
 
Determined mainly by the distance from the tip of the central core to the distal tip of the wire.
 
Important in minimizing vascular trauma
 
=====RADIOOPACITY / VISIBILITY=====
 
Useful as a marker, measure of length, helps maintain focus on the lesion while the tip is in the peripheral visual field.
 
Platinum at the end of the wire gives radio-opacity
 
May mask anatomy, eg dissection
 
=====TRACKABILITY=====
 
Is the ability of the wire to follow the wire tip without bucking or kinking.
The term may also refer to a stent or a balloon.
 
=====PROLAPSE TENDENCY=====
 
 
=====TACTILE FEEDBACK=====
 
Is the “feel” of the wire tip’s behavior perceived by the operator. This is better appreciated with coil tipped wires, whereas polymer tipped wires it may be minimal or absent, making inadvertent perforation, dissection or traversing a plaque more likely.
 
 
===[[COMMONLY USED GUIDEWIRES]]===
 
There is no uniform clinical classification of guide wires.
 
A commonly used somewhat crude classification is based on
 
1. Support ( steerability and trackability. )
 
=====Soft guide wires=====
*Asahi soft
*Hi-torque balance
 
=====moderate support=====
 
*Wizdom
*High torque balance middle weight
 
 
=====extra support=====
*ChoICE PT extra support
*PT Graphix intermediate
*Stabilizer
*Hi-torque balance heavy weight
 
=====Super extra support=====
*Iron man
*Asahi grand slam
 
2. Crossing profile
 
2.1 Simple lesions
 
2.2 Complex lesions and lesions in very tortuous vessels
*Prowater
*ChoICE PT
*PT graphix intermediate
 
2.3 Chronic total occlusions
*Cross it series
*Miracle bro series
*Shinobi
*Confianza
 
3. Device delivery wires
*Stablizier
*Wiggle
 
===[[COMMONLY USED GUIDE WIRES]]===
 
===ASAHI SOFT / LIGHT GUIDE WIRE===
 
 
[[Image:Asahi_soft.jpg]]
 
*Hydrophobic Coating
*Soft tip
*Flexible body
*Support to deliver most interventional devices
*Tip load: 0.5 g
*Radiopaque length: 3 cm
*Outside diameter: 0.014"
*Total length: 180 cm – 300 cm
 
 
===ASAHI PROWATER AND PROWATER FLEX===
 
Relatively safe guide wire with moderate support.
 
[[Image:Asahi_prowater_and_prowater_flex.jpg]]
 
Source : http://www.abbottvascular.com/
 
*Has a hybrid Coating: Soft hydrophobic tip & hydrophilic working coils. Hydrophilic coating maximizes lubricity to navigate anatomy and hydrophobic coating designed to enhance tactile feel.
*Uses  “TruTorq” technology - a design that fuses stainless steel to platinum spring coils via a single-joint. (claimed to afford the improved torque response and steerability seen with this wire.)
*Tip load: 0.8 g
*Radiopaque length: 3 cm
*Outside diameter: 0.014"
*Total length: 180 cm, 300 cm
 
===ACS HI TORQUE BALANCED MIDDLE WEIGHT (BMW)===
 
===ACS HIGH TORQE BALANCE MIDDLE WEIGHT (BMW) UNIVERSAL===
 
Shaping ribbon provides reasonable provision for shape retention & tip softness
 
Intermediate coils at the tip maintain .014" diameter for smooth device delivery
 
*Hydrophobic or Hydrophilic coating for tracking
 
 
[[Image:Asahi_Tru_Torq_Steel.jpg]]
 
====HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL====
 
 
[[Image:BMW_universal.jpg]]
 
 
Durasteel shaping ribbon material provides added durability and shape retention
 
Intermediate section has both a hydrophilic coating and a polymer cover
 
===PT GRAPHIX INTERMEDIATE===
 
Figure  Source http://www.bostonscientific.com
 
===ChoICE PT ===
 
Excellent in crossing moderately difficult lesions and negotiating tortuous lesions.
 
[[Image:CPT.jpg]]
 
Crossing guide wire with light rail support.
 
Unibody stainless steel
Polymer tip
Hydrophilic ICE coating
Radioopaque length 35 cm
Outside diameter 0.014”
Available lengths182cm, 300 cm
Compatible with magnet Exchange Device
 
===ChoICE PT Extra support===
 
Crossing guide wire with extra rail support
 
Figure CPT XS jpg
 
Unibody stainless steel
Polymer tip
Hydrophilic ICE coating
Radioopaque length 35 cm
Outside diameter 0.014”
Available lengths 182cm, 300 cm
Compatible with Magnet Exchange Device
 
===ChoICE Floppy guide wire===
 
Relatively atraumatic guide wire with light rail support.
 
Figure Choice jpg
 
Unibody stainless steel
Spring tip, polymer sleeve
ICE hydrophilic coating
 
Radioopaque length 3 cm
Outside diameter 0.014”
Available lengths 182cm, 300 cm
Compatible with Magnet Exchange Device
 
===ChoICE Extra support===
 
Delivery support wire with extra rail support.
 
 
[[Image:CPT_XS.jpg]]
 
=====BASIC CONSTRUCTION=====
 
Unibody stainless steel core
Spring tip, Polymer sleeve
ICE hydrophilic coating
Radioopaque length 3 cm
Outside diameter 0.014”
Available lengths 182cm, 300 cm
Compatible with Magnet Exchange Device
 
====WHISPER====
[[Image:Whisper.jpg]]
 
Durasteel™ Core-to-tip designed to improve steering, durable shape retention and tactile feedback
 
Full Polymer cover with Hydrophilic coating intended for deliverability and smooth lesion access
 
Responsease™ “transitionless” core grind designed to provide improved tracking and better torque response
 
Tip coils designed to provide softer, shapeable tip and also improve tactile feedback
 
 
 
====STABILIZER EXTRA SUPPORT====
 
==== WIZDOM====
 
:
 
:
 
 
=====WIGGLE WIRE=====
 
This wire has a niche role in delivering stents and balloons in to areas with poor transmission of proximal push. It works by shifting the direction of the pushing forces thus "stepping over" the :obstacle".
 
 
 
=====IRON MAN GUIDEWIRE=====
 
Stiff wire with poor steerability. Its rigidness is used to straighten vessel segements and allow better transmission of forces pushing balloons or stents.  This property comes from the tendency of the wire to retain its shape rather than conform to the contours of the vessel. This feature makes “cheese cutter” effects on the vascular intima at their bends. This some times is demonstrated angiographically by a “pleating artifact” and in extreme situations could lead to a transient “no-reflow” state. ( Figure) Though this wire will allow transmit more force to the balloon or the stent, it could actually make device delivery more difficult in tortuous vessels.
 
===GUIDE WIRES PRIMARILY USED FOR CHRONIC TOTAL OCCLUSIONS===
 
===CROSS IT GUIDE WIRES===
 
1. CROSS IT XT 100
 
Cross it 100 xt
 
Figure source:  http://www.abbottvascular.com
 
 
Tapered tip coil from 0.014" to 0.010" at distal 3 cm
Hydrocoat hydrophilic coating of distal 30 cm
 
 
:
 
2. Cross it 200 XT
 
 
Cross it 200 xt
 
 
 
 
 
3. Cross it 300 XT
 
Cross it 300 xt
 
 
 
===PILOT WIRES===
 
===Pilot 50, 150, 200===
 
 
 
 
Figure
:
 
====PERSUADER ====
 
These wires are mainly used to cross challenging chronic total occlusions
 
Core to tip family used mainly for CTOs
 
 
Figures source    http://www.medtronic.com
 
=====PERSUADER 3====
 
Persuader 3jpg
 
====PERSUADER 6====
 
Persuader 6jpg
 
 
====PERSUADER 9====
Persuader 9jpg
 
 
 
 
===ASAHI MIRACLE BRO===
 
These wires are mainly used to cross challenging chronic total occlusions
Core to tip guidewires
 
 
===ASAHI MIRACLE BRO 3===
 
1. Asahi miraclebros 3.JPG
 
Tip load: 3 g
Radiopaque length: 11 cm
Outside diameter: 0.014"
Total length: 180 cm
 
2. Asahi Miraclebro 4.5
 
Asahi miraclebros 45.JPG
 
 
Tip load: 4.5 g
Radiopaque length: 11 cm
Outside diameter: 0.014"
Total length: 180 cm
 
3. Asahi Miraclebro 6
 
Asahi miraclebros 6.JPG
 
Tip load: 6 g
Radiopaque length: 11 cm
Outside diameter: 0.014"
Total length: 180 cm
 
4. Asahi Miraclebro 12
 
Asahi miraclebros 12.JPG
 
Tip load: 12 g
Radiopaque length: 11 cm
Outside diameter: 0.014"
Total length: 180 cm
 
=====STEEL CORE=====
 
===ZINGER GUIDEWIRE===
 
===COUGAR GUIDEWIRE===
 
===THUNDER GUIDEWIRE===
 
=====ASAHI GRAND SLAM=====
 
The tip is very flexible, hence less traumatic, but provides considerable support.
Tip load: 0.7 g
Radiopaque length: 3 cm
Outside diameter: 0.014"
Total length: 180 cm, 300 cm
 
 
Asahi grand slam jpg.
 
=====SPARTACORE=====
 
This wire is mainly used in peripheral interventions.
 
 
 
=====V 18=====
 
This is a .018” wire mainly used in the peripheral interventions. It is a stiff wire with excellent torque control, tendency to prolapse and perforation.
 
====STEERABLE GUIDE WIRES====
 
====Cordis ATW™ All Track Wire====
FIG CORDIS STEERABLE GUIDE WIRE
 
Moderate Support
General Purpose
Precision Control from Hand to Tip
Precise steerability for lesion access
Enhanced flexibility for tracking in tortuous vessels
Highly lubricious, durable platform for smooth delivery of multiple devices
The ATWTM Guidewire atraumatic floppy tip and integrated FLEX-JOINTTM Bond combine for distal flexibility and atraumatic vessel tracking
 
==== Torquer / steering tool====
 
Used to maintain an achieved torque. There is a gradual inadvertent “unwinding” of torque with human fingers which can be effectively prevented by this tool.
 
Two types are commonly used.
 
====TIPS IN CROSSING A LESION====
 
1. Use a bend at the tip of the wire which is roughly the length of the diameter of the vessel proximal to the lesion.
2. If a wire repeatedly fails to cross a lesion,
a. Adjust the guide,
b. Use a balloon, transit, ultrafuse or twin pass catheter to direct the wire
c. modify the bend at the tip.
d. change the wire ( check the tip of the wire for evidence of wear and tear)
3. A wire in a balloon or a catheter ( ultrafuse, transit or exchelon) may help guide the wire through the lesion
 
 
==SAFETY TIPS==
 
1. Get used to a few wires to suit most situations
2. Always use the least traumatic wire for the lesion, >90% lesions could be crossed with standard “work horse” wires
3. Until familiar and comfortable, do not rush in to wires which are mote likely to perforate.
4. Avoid bending or buckling the wire
5. Never push a wire, let it find its “track” with
6. A ventricular premature beat could be a suggestion that the wire is off track, withdraw the wire immediately and redirect it.
7. Check every fluro and cine loop for evidence for perforation, embolization and dissection. If the picture quality is poor, then do not hesitate to increase the frame count/radiation to improve it.
8. If there is a suspicion of a perforation, then an emergent Echo should be performed on the table. ( link complications – perforation)
 
 
==COMMON PITFALLS==
 
 
==TROUBLE SHOOTING==
 
 
===TRAPPED WIRE ===
 
May occur with
 
*calcified vessels ( eg RCA) at the tip.
 
May be prevented by avoiding using the same wire on multiple interventions or multiple crossing.
 
My need to advance a small profle balloon or a small caliber catheter (transit) to the “attachement” site and use traction. Caution : Perforation.
 
* May occur when a buddy wire gets trapped between a stent and the vessel wall. Gentle traction may bring the wire out of the stent. The coating of the tip may “deglove” and be left behind, which could be “pushed and pasted” against the vessel wall with another stent. May need surgery to retrieve it. The tip may completely detach, then the management is as above.
 
===DETACHMENT OR EMBOLISATION OF END OF THE WIRE===
 
Uncommon with most modern wires.
 
====Management====
 
There is no data to guide management. Clinical judgment should be used.
 
May have to snare it.
 
May be left in situ, speacially if small and unable to retrieve. Could use a stent to “push and paste” it to the vessel wall.
 
Surgery may be needed.
 
===WIRE FRACTURE IN A CORONARY VESSEL===
 
This should be identified immediately and the wire should be replaced. It could give rise to the situations mentioned above.
 
 
==GUIDEWIRES BY MAJOR MANUFACTURERS==
 
===Abbott vascular===
 
1.1 Asahi
 
*Asahi by Abbott vascular
*ASAHI Confianza Coronary Guide Wires
*ASAHI Grand Slam Coronary Guide Wires
*ASAHI Light Coronary Guide Wires
*ASAHI Medium Coronary Guide Wires
*ASAHI Miracle Bros Coronary Guide Wires (3g, 4.5g, 6g and 12g)
*ASAHI Prowater Coronary Guide Wires
*ASAHI Prowater Flex Coronary Guide Wires
*ASAHI Standard Coronary Guide Wires
 
1.2 Balance wires by Abbott vascular
 
BALANCE (HI-TORQUE BALANCE Coronary Guide Wire)
BALANCE (HI-TORQUE BALANCE MIDDLEWEIGHT UNIVERSAL Coronary Guide Wire)
 
1.3 HI-TORQUE CROSS-IT XT Coronary Guide Wire by Abbott vascular
*100 XT
*200 XT
*300 XT
 
===Medtronic===
*Cougar
*Zinger
*Persuader
*Thunder
 
===Boston Scientific===
 
Crossing guide wires
*ChoICE PT
*ChoICE PT Extra support
*PT
*PT Graphix Intermediate
*Forte
*IQ
*Luge
*Mailman
 
mailman.jpg, Delivery support guidewire super support rail for straightening of vessel. Spring tip with polymer sleeve, unibody stainless steel, hydrophilic coating 3 cm radioopacity, diameter .014”
 
===cordis===
 
*ATW™All Track Wire
*ATW™Marker Wire
*WIZDOM® Steerable Guidewires
*WIZDOM® ST Steerable Guidewires
*STABILIZER® Balanced Performance Steerable Guidewires
*STABILIZER® Plus Steerable Guidewires
*STABILIZER® XS Steerable Guidewires
*STABILIZER® Marker Wire
*SHINOBI® Steerable Guidewires
*SHINOBI® Plus Steerable Guidewires
*REFLEX® Steerable Guidewires
 
*Steer it Deflecting Tip Guidewire E-1
 
Steerable Guidewire Accessories
 
*CINCH® QR Extension Wire
*EASY TWIST® Torquing Device
 
 
==REGIONAL AND GLOBAL PRACTICES==
 
===USA===


===CANADA===
[[Guidewire Core Diameters]] | Guidewire Wisdom | [[Guidewire Tip Diameters]] | [[Guidewire Lengths]]


===MEXICO===
==Guidewires Classified Based Upon Support (Steerability and Trackability)==


===SOUTH AMERICA===
===Soft Guidewires===
[[Guidewire Asahi soft| Asahi Soft Guidewire]] | Hi-torque Balance


===EUROPE===
===Moderate Support Guidewires===
[[Guidewire wisper wire|Wisper Wire]] | [[Guidewire High torque balance middle weight|High Torque Balance Middle Weight]]


===Australia===
===Extra Support Guidewires===
[[Guidewire choice PT extra support|Choice PT Extra Support]] | PT Graphix Intermediate | Stabilizer | [[Guidewire hi-torque balance heavy weight|Hi-Torque Balance Heavy Weight]]


===New Zealand===
===Super Extra Support Guidewires===
[[Guidewire iron man|Iron Man]] | [[guidewire asahi grand slam|Asahi Grand Slam]]


===CHINA===
==Guidewires Classified By Crossing Profile==


===INDIA===
===Complex lesions and lesions in very tortuous vessels===
[[Guidewire prowater|Prowater]] | [[Guidewire Choice PT|Choice PT]] | PT Graphix Intermediate


===SOUTH EAST ASIA===
===Guidewires Used to Cross Chronic Total Occlusions===
Wires to be used in escalating order of aggressiveness:
====First Choice====
'''Non-hydrophilic''' or '''hydrophobic''' wires with an '''intermediate stiffness''' are a good first choice as they have a better tactile response, are less likely to lead to a subintimal position than a hydrophilic wire, and may have an additional advantage in their ability to cross the proximal cap of the occlusion. Choices in this class include the [[Miracle Bros]] 3 and the [[Asahi intermediate wires]].
====Second Choice====
'''Hydrophilic''' wires may track better after the proximal cap of the occlusion has been crossed.  Hydrophilic/coated wires have better maneuverability in [[tortuosity|tortuous]] or [[calcification|calcified]] vessels.  '''Intermediate stiffness hydrophilic wire''' choices include the [[Choice PT XS (Extra Support)]], the [[Pilot 50]], the [[Pilot 100]] or the [[PT Graphix intermediate wire]].


===AFRICA===
====Third Choice====
'''Stiff non-hydrophilic wires''': The [[Miracle Bros]] 6, 9 and 12, [[Cross-IT]], [[Confienza]], [[Persuader]]
====Fourth Choice====
'''Stiff and hydrophilic (most aggressive)''': [[Pilot 200]] and [[Shinobi]]


---------------------------------------------------
==Device Delivery Guidewires==
Guidewire wiggle wire- The wiggle wire has a niche role in delivering stents and balloons into areas with poor transmission of proximal push.  The wiggle wire works by shifting the direction of the pushing forces thus "stepping over" the obstacle.


==REFERENCES==
==Peripheral Arterial Guidewires==
* Spartacore - The Spartacore is a peripheral arterial guidewire.
* Guidewire V 18


1. Arce-Gonzalez JM, Schwartz L, Ganassin L, Henderson M, Aldridge H: Complications associated with the guide wire in percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 10: 218-221, 1987.
==Guidewire Tourquing Device==
A torquing device is a tool interventional cardiologists use to torque a coronary guidewire and to maintain the tension on the guidewire to preserve the torque and the direction the guidewire. There is a gradual inadvertent “unwinding” of torque when the human fingers are used to steer a coronary guidewire, and this unwinding can be effectively prevented by this tool.


2. Hartzler GO, Rutherford BD, McConahay DR: Retained percutaneous transluminal coronary angioplasty equipment components and their management. Am J Cardiol 60:1260-1264, 1987.
==[[List of Guidewires by Manufacturer]]==


3. Serota H, Deligonul U, Lew B, Kern MJ, Aguirre F, Vandomael M: Improved method for transcatheter retrieval of intracoronary detached angioplasty guidewire segments. Cathet Cardiovasc Diagn 17:248-251, 1989. 218-221, 1987


{{SIB}}


[[Category:Cardiology]]
[[Category:Cardiology]]
Line 837: Line 75:
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
{{mdr}}

Latest revision as of 21:49, 28 January 2013

WikiDoc Resources for Guidewire

Articles

Most recent articles on Guidewire

Most cited articles on Guidewire

Review articles on Guidewire

Articles on Guidewire in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Guidewire

Images of Guidewire

Photos of Guidewire

Podcasts & MP3s on Guidewire

Videos on Guidewire

Evidence Based Medicine

Cochrane Collaboration on Guidewire

Bandolier on Guidewire

TRIP on Guidewire

Clinical Trials

Ongoing Trials on Guidewire at Clinical Trials.gov

Trial results on Guidewire

Clinical Trials on Guidewire at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Guidewire

NICE Guidance on Guidewire

NHS PRODIGY Guidance

FDA on Guidewire

CDC on Guidewire

Books

Books on Guidewire

News

Guidewire in the news

Be alerted to news on Guidewire

News trends on Guidewire

Commentary

Blogs on Guidewire

Definitions

Definitions of Guidewire

Patient Resources / Community

Patient resources on Guidewire

Discussion groups on Guidewire

Patient Handouts on Guidewire

Directions to Hospitals Treating Guidewire

Risk calculators and risk factors for Guidewire

Healthcare Provider Resources

Symptoms of Guidewire

Causes & Risk Factors for Guidewire

Diagnostic studies for Guidewire

Treatment of Guidewire

Continuing Medical Education (CME)

CME Programs on Guidewire

International

Guidewire en Espanol

Guidewire en Francais

Business

Guidewire in the Marketplace

Patents on Guidewire

Experimental / Informatics

List of terms related to Guidewire

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Priyantha Ranaweera [2];

Key Words and Synonyms: PCI guidewire; angioplasty guidewire; coronary guidewire; steerable wire; steerable guidewire.

Overview

Angioplasty guidewires are small, soft, flexible, lubricated, wires that act as a rail over which equipment such as an angioplasty balloon, a stent, or an intravascular ultrasound device can be delivered over into the coronary artery. Angioplasty guide wires were introduced in 1982 by doctors Simpson and Roberts. The introduction of coronary guidewires was a major advance as it allowed the angioplasty balloon to be a traumatically steered to the proper location.

Guidewire Techniques

Guidewire Complications

Desirable Performance Characteristics of Coronary Guidewires

Guidewire Design Features

A guidewrie has three main components - a core, a tip and a lubricous Coating.

Figure : Components of a guide wire (courtesy : Abbott vascular inc)

Guidewire Core | Guidewire Coatings | Guidewire Tip

Guidewire Core Diameters | Guidewire Wisdom | Guidewire Tip Diameters | Guidewire Lengths

Guidewires Classified Based Upon Support (Steerability and Trackability)

Soft Guidewires

Asahi Soft Guidewire | Hi-torque Balance

Moderate Support Guidewires

Wisper Wire | High Torque Balance Middle Weight

Extra Support Guidewires

Choice PT Extra Support | PT Graphix Intermediate | Stabilizer | Hi-Torque Balance Heavy Weight

Super Extra Support Guidewires

Iron Man | Asahi Grand Slam

Guidewires Classified By Crossing Profile

Complex lesions and lesions in very tortuous vessels

Prowater | Choice PT | PT Graphix Intermediate

Guidewires Used to Cross Chronic Total Occlusions

Wires to be used in escalating order of aggressiveness:

First Choice

Non-hydrophilic or hydrophobic wires with an intermediate stiffness are a good first choice as they have a better tactile response, are less likely to lead to a subintimal position than a hydrophilic wire, and may have an additional advantage in their ability to cross the proximal cap of the occlusion. Choices in this class include the Miracle Bros 3 and the Asahi intermediate wires.

Second Choice

Hydrophilic wires may track better after the proximal cap of the occlusion has been crossed. Hydrophilic/coated wires have better maneuverability in tortuous or calcified vessels. Intermediate stiffness hydrophilic wire choices include the Choice PT XS (Extra Support), the Pilot 50, the Pilot 100 or the PT Graphix intermediate wire.

Third Choice

Stiff non-hydrophilic wires: The Miracle Bros 6, 9 and 12, Cross-IT, Confienza, Persuader

Fourth Choice

Stiff and hydrophilic (most aggressive): Pilot 200 and Shinobi

Device Delivery Guidewires

Guidewire wiggle wire- The wiggle wire has a niche role in delivering stents and balloons into areas with poor transmission of proximal push. The wiggle wire works by shifting the direction of the pushing forces thus "stepping over" the obstacle.

Peripheral Arterial Guidewires

  • Spartacore - The Spartacore is a peripheral arterial guidewire.
  • Guidewire V 18

Guidewire Tourquing Device

A torquing device is a tool interventional cardiologists use to torque a coronary guidewire and to maintain the tension on the guidewire to preserve the torque and the direction the guidewire. There is a gradual inadvertent “unwinding” of torque when the human fingers are used to steer a coronary guidewire, and this unwinding can be effectively prevented by this tool.

List of Guidewires by Manufacturer


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Guidewire&oldid=836604"